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PHAR324 > Geriatric PK > Flashcards

Geriatric PK Flashcards

1
Q

Why are older adults a special population?

A

health:
-heterogenous population
-aging process is unpredictable
-multiple simultaneous disease states
-chronic illness
changing demographics:
-population composition, institutionalization
epidemiology of drug use in the older adult:
-polypharmacy
-underuse of potentially beneficial therapy
drug effect:
-3 to 10 fold greater ADRs
available PK/PD information:
-evidence based for prescribing in older adults is limited
-clinical studies not representative of older adult population

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2
Q

What do age-related changes in organ function impact?

A

alters drug PK and PD resulting in alterations in pharmacological response

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3
Q

True or false: physiological aging correlates with chronological aging

A

false
physiological aging does not necessarily correlate with chronological aging

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4
Q

Are age-related changes themselves enough to compromise normal function?

A

age-related changes in-of-themselves are often not sufficient to compromise normal function
-however with underlying pathological conditions (e.g. HF, renal decline). such age-related changes may have significant consequences on PK/PD

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5
Q

What are the changes in body composition with aging?

A

decreased total body water; decreased ICF volume
decreased lean body mass and increased body mass
no change or decrease in serum albumin
no change or increase in serum AAG

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6
Q

What are the cardiovascular changes with aging?

A

decreased myocardial sensitivity to B-adrenergic stimulation
decreased baroreceptor activity
decrease CO; decreased resting HR
increased systemic vascular resistance; increased SBP

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7
Q

What are the CNS changes with aging?

A

decreased weight and volume of the brain
decreased cerebral blood flow
increased BBB permeability
alterations in cognition

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8
Q

What are the endocrine system changes with aging?

A

thyroid gland atrophy
menopause
decrease testosterone
increased incidence of diabetes and thyroid disease

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9
Q

What are the fluid/electrolyte changes with aging?

A

increased electrolyte abnormalities

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10
Q

What are the GI system changes with aging?

A

no change or sometimes increased gastric pH
delayed gastric emptying
decreased splanchnic blood flow; decreased intestinal rate
decreased absorptive surface (mucosal atrophy)
no change passive intestinal permeability; decreased active nutrient transport

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11
Q

What are the GU system changes with aging?

A

increased incidence of UI

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12
Q

What are the immune system changes with aging?

A

decreased cell-mediated immunity

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13
Q

What are the liver changes with aging?

A

decreased liver size and number of hepatocytes
decreased liver blood flow
? oxidative and conjugative metabolism

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14
Q

What are the MSK changes with aging?

A

increased cartilage breakdown in joints
increased bone porosity; decreased BMD
decreased muscle size and mass; decreased peripheral neurons

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15
Q

What are the nutrition changes with aging?

A

possible protein energy malnutrition
increased anorexia and micronutrient deficiences

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16
Q

What are the pulmonary system changes with aging?

A

decreased respiratory muscle strength and chest wall compliance
decreased total alveolar surface
decreased vital capacity

17
Q

What are the renal system changes with aging?

A

decreased GFR; decreased renal blood flow
increased tubular atrophy and decreased tubular secretory function
decreased compensatory acid-base and electrolyte balance
decreased renal mass and increased fibrosis and arterosclerosis

18
Q

What are the sensory changes with aging?

A

decreased accommodation of the lens of the eye
decreased visual and auditory acuity

19
Q

What are the integument changes with aging?

A

increased dryness, wrinkles; decreased # hair follicles and melanocytes
increased epithelial thinning and loss of dermal thickness
decreased wound healing and thermoregulation
decreased vitamin D function and increased photosensitivity

20
Q

What does Css depend on?

A

Css = F x dose/Cls

21
Q

What does t1/2 depend on?

A

t1/2 = 0.693 x Vd/Cls

22
Q

What do age-related changes in GIT absorption lead to?

A

impaired/delayed drug absorption as rate and/or extent of absorption is altered
-usually clinically irrelevant

23
Q

What is an important GI change in PK?

A

may see decreased 1st pass effect = increased F for high Eh drugs

24
Q

What is Vd influenced by?

A

age-related changes in:
-body composition
-blood flow rates
-binding to biologic material

25
Q

Describe the PK changes in distribution seen with aging.

A

decreased Vd and increase Cp of water soluble drugs
increased Vd and increased t1/2 if fat soluble drugs
increased or decreased or no change in fub of highly PPB drugs
-increased fub for drugs bound to albumin
-decreased fub for drugs bound to AAG
if Vd increased then t1/2 increased and should increase dosing interval

26
Q

Which phase of metabolism is impacted by aging?

A

phase 1 more affected
limited alterations in phase 2 metabolism

27
Q

What is the effect of aging on Clint?

A

Clint associated with extensive interindividual variability; therefore it is difficult to assess the effect of age on hepatic drug metabolizing activity

28
Q

Describe the PK changes in metabolism seen with aging.

A

decreased Cls and increased t1/2 for some low Eh drugs
decreased Qh and decreased Clh for high Eh drugs

29
Q

Why is SCr misleading in older patients?

A

decreases in GFR with age may be matched by decreases in muscle mass and urinary excretion of creatinine

30
Q

Which renal parameters decline with age?

A

RBF
GFR
tubular secretion

31
Q

Describe the PK changes seen in excretion with aging.

A

decreased Cls and increase t1/2 of renally eliminated drugs
increased t1/2 and increased time to reach SS

32
Q

When are changes to the LD needed?

A

when changes to Vd

33
Q

When are changes to the MD needed?

A

when changes in Cls to maintain Css

34
Q

When are changes to dosing interval needed?

A

Vd influences t1/2 which influences time to reach SS
Cls influences t1/2 which influences time to reach SS

35
Q

What is the effect of age on drug response?

A

effect of age on the sensitivity to drugs varies with the studied and response measured
-older adults may have a greater or reduced response at a given Cp vs young adult

36
Q

Which body systems do we primarily see age-dependent changes in PD?

A

CV and neuroendocrine
-more sensitive to BZDs, narcotics, anticoagulants, antihypertensives
-increased NSAID adverse effects

37
Q

Why do older adults have altered drug responses?

A

altered homeostatic responses to drugs and altered drug responses induced by chronic disease
age-related changes in PD not easily predicted; titrate dose according to response

38
Q

What are the common interactions with aging?

A

drug-drug interaction
drug-nutrition interaction
drug-disease interaction

PHAR324 (11 decks)

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